The Placebo Effect: How Deep Does It Go?

I’ve always been fascinated by the placebo effect: the phenomenon in medicine where people can experience healing benefits from a fake medicine if they believe the medicine is real. How is it that a sugar pill can be equally or even more effective than an actual medication designed to treat a particular ailment? This has always struck me as intriguing evidence of the mind’s role in healing—a major theme of A Course in Miracles. How deep does this effect go? No one knows, but researchers are discovering some very interesting and even downright odd manifestations of it. For instance, I recently came across some findings on the placebo effect which suggest that something very odd indeed is at work: The placebo effect in trials of painkillers is actually increasing—but strangely enough, only in America.

A new study recently published by researchers at McGill University in Canada examined 84 trials of pain medications in the last 23 years. In US trials done in 1993, the actual pain medications were found to be 27 percent more effective than placebo pills, but by 2013, the gap had shrunk to only 9 percent. This gap was attributed not to decreased effectiveness of the medicine but to increased effectiveness of the placebo. Strangely, this change in placebo effectiveness didn’t appear in the trials performed in other countries over the same period.

Why the strong geographical difference? The researchers don’t really know. Their best explanation, which they acknowledge is pure speculation, is that because drug trials in the US (but not in other countries) are much longer, more expensive, and more highly publicized than in the past, patients have higher confidence in the drugs being tested—higher confidence that would increase the placebo effect. If participants in a trial have been reading daily headlines about that promising new pain reliever being tested on them, they are going to be more confident going into that trial that what they take is going to work. At any rate, the placebo effect in America is now so strong that drug companies are having a difficult time proving that their drugs are more effective than placebos.

As I said, I find the placebo effect fascinating. It has been shown to work in many contexts with many kinds of medication. It’s not just a subjective “I believe it will make me feel better so I tell myself I feel better” sort of thing; studies have shown that placebos have measurable physical effects. Studies have even shown that the placebo effect works when test subjects know they are being given a placebo. The effect is so strong that it is worth asking “why the bald facts of the placebo phenomenon…have not yet launched a thousand inquiries into the mind’s treatment powers” (Harris Diestfrey, quoted in Irreducible Mind: Toward a Psychology for the 21st Century, p. 140).

A big reason, according to psychologist Emily Williams Kelly, is that modern medical science is highly skeptical of the whole idea of “the mind’s treatment powers.” The prevailing model today is a strictly materialist model in which “mind” is merely the product of physical processes, and the idea of a “mind” actually affecting physical processes is difficult to fit into that model. Medical science is thus in an odd quandary: There is an effect so strong it must be accounted for, yet that effect runs so contrary to the biomedical model that it can’t be explained. As Kelly puts it:

Placebo’s “odd” place, therefore, is that, on the one hand, it has been so thoroughly accepted by the medical community that it is now an obligatory factor in the experimental design of studies of the efficacy of medical treatments; and yet on the other hand, there has been virtually no effort until recently to understand the “enigma” of the placebo itself and its apparent conflict with the biomedical model. (Irreducible Mind, p. 140)

What would A Course in Miracles say about this? If the medical profession is reluctant to face the logical ramifications of the placebo effect, it likely would not want to touch the Course with a ten-foot pole. In characteristic fashion, the Course takes what we call the placebo effect and carries it to the absolute extreme: In its view, those medicines being tested actually aren’t any more effective than placebos, because all physical medicines are placebos. Illness isn’t just affected by the mind; it is caused entirely by the mind, and physical medicines are given whatever effects they have only by the mind’s desire for a remedy. In the Course’s words:

The acceptance of sickness as a decision of the mind, for a purpose for which it would use the body, is the basis of healing. And this is so for healing in all forms. A patient decides that this is so, and he recovers. If he decides against recovery, he will not be healed. Who is the physician? Only the mind of the patient himself. The outcome is what he decides that it is. Special agents [i.e., physical medicines] seem to be ministering to him, yet they but give form to his own choice. He chooses them in order to bring tangible form to his desires. And it is this they do, and nothing else. They are not actually needed at all. The patient could merely rise up without their aid and say, “I have no use for this.” There is no form of sickness that would not be cured at once. (M-5.II.2:1-13)

Wow! I’ve been studying the Course for years and have come to accept the plausibility of what is said here, but I still find it stunning. How can this be? How can it be true that every illness and every remedy is a product of the mind? How can it be true even in cases where a person is in a coma and thus doesn’t consciously know she is ill and medicine is being administered? How can it be true for animals and plants, which obviously respond to medical treatments even though they presumably aren’t thinking “I really believe in this medicine”?

I think the Course has to be talking about a very deep level of mind here. Causation of illness and belief in a remedy aren’t primarily surface phenomena, though of course at times they may rise to the surface. Rather, they must come from deep within nonphysical minds (nonphysical minds that, the Course implies, even animals and plants possess). This would actually explain quite a lot. It would explain, for instance, why simply doing affirmations or other “mind over matter” techniques to cure an illness usually doesn’t work. Such things can be useful and sometimes they do work, but usually they simply don’t go deep enough.

It is the Course’s goal to take us, step by step, into the deep place within us where the cause and remedy of illness really lie. And in its discussion of the root cause of illness and the remedy that naturally follows from that cause, it seems to me that the Course truly breaks new ground. It is commonplace in alternative spiritual circles to hear that mental states have a powerful effect on physical illness, and that we can use the mind to heal the body. But I’ve never heard anything quite like the Course’s take on this issue. For better or worse, as far as I can see, the Course stands on its own.

In the Course’s view, illness is caused by deep, primordial guilt; indeed, the Course tells that “guilt is…the sole cause of pain in any form” (T-30.V.2:4). We feel profoundly guilty for separating from God and our brothers-a separation that not only happened long ago, but is kept in place in the present through our moment-by-moment decisions to attack and condemn each other-and sickness projected onto our entirely illusory bodies is our self-imposed punishment for our guilt. As long as this guilt remains, even if we recover from a particular form of illness at a particular time (which does, of course, happen frequently), we remain prone to sickness in other forms, for “the cause remains, and will not lack effects” (S-3.II.1:5).

If the cause is guilt, then the remedy must be forgiveness. And since our guilt is usually projected outward in the form of condemning our brothers—the very condemnation that keeps the separation in place—our own sickness is healed above all by forgiving our brothers: “Only in someone else can you forgive [and therefore heal] yourself, for you have called him guilty of your sins, and in him must your innocence now be found” (S-2.I.4:6). And thus, strikingly, the Course goes beyond not only the usual materialist view that the body causes illness, but also beyond the common view in alternative spirituality that the mind causes illness and we can heal ourselves just by affirming the power of the mind. The Course tells us that illness is caused by our condemnation of others and ourselves, and is healed through our replacing that condemnation with forgiveness. In other words, illness is caused by our mind’s decision to attack, and is healed through our mind’s decision to love.

This leads directly to a Course idea that I find truly moving and profound: The health of the body depends entirely on how we use it. The body gets sick because we’re using it to attack and condemn our brothers and thus ourselves. The Course’s beautiful promise is that when we finally learn to use the body only for the purpose of extending forgiveness and love to our brothers (and I think “only” is the crucial word here), the body will be entirely healed:

The Holy Spirit teaches you to use your body only to reach your brothers, so He can teach His message through you. This will heal them and therefore heal you. Everything used in accordance with its function as the Holy Spirit sees it cannot be sick. Everything used otherwise is.…Do not let [the body] reflect your decision to attack. Health is seen as the natural state of everything when interpretation is left to the Holy Spirit, Who perceives no attack on anything. Health is the result of relinquishing all attempts to use the body lovelessly. (T-8.VIII.9:1-4, 7-9)

I love that last line! “Health is the result of relinquishing all attempts to use the body lovelessly.” What a beautiful idea!

We’ve come a long way here from the simple notion that the mind can affect the body through believing in a placebo—a very long way. All of this sounds far-fetched, it is true. The Course acknowledges our doubts about this extreme position, admitting that “certainly sickness does not appear to be a decision” (M-22.4:1). This is a teaching that I think needs to be reflected upon and applied with gentleness, open-mindedness, humility, and compassion, especially in the face of our and others’ illnesses. Tender loving care for others and ourselves-love rather than condemnation-is what this teaching looks like in practice. God forbid that we use it as a bludgeon when sick people come to us for help. The old “What did you do to create that?” routine never healed anyone.

As extreme as the Course’s view is, I personally feel a deep affinity with the idea that in the final analysis, the end of sickness is the decision to lay down our condemnation and join with one another in a truly selfless, kindhearted, forgiving love. Whether the Course’s teaching here is true or not, only time will tell. There’s certainly no definite proof of it at this time, and it must be admitted that the vast majority of Course students wrestle with sickness just like everyone else. But I’m heartened by the preliminary evidence that placebo studies seem to offer, and I hope that the trend toward doing more research into the mind’s affect on physical healing continues.

Who knows how deep the placebo effect really goes? Perhaps it goes deeper than we ever imagined. Perhaps in time each of us will experience the joy that comes when “peace fills my heart, and floods my body with the purpose of forgiveness” (W-pII.267.1:3). Perhaps then we will see the Son of God in all our brothers, and we will hear the Holy Spirit proclaim the truth that sets us all free: “Behold His sinlessness, and be you healed” (W-pII.357.1:5). Sure beats a sugar pill!